Social marketing and condoms: From Thailand to the United States during the AIDS crisis

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“Mr. Condom” may not have been the nickname Mechai Viravaidya aspired to have, but it’s the one he got — and he’s honored. 

In 1974, Thailand tackled poverty with an unconventional approach: promoting the use of condoms. That same year, the average Thai family had seven children. Women didn’t have many opportunities outside the home, and supporting a large family was next to impossible on small wages during a recession. 

Rather than control the population by limiting the amount of children people could have by law, Mechai Viravaidya wondered if condom marketing and distribution alone could reduce the size of families over time. Viravaidya, a former minister who was frustrated by the Thai government’s inability to set a national family planning policy, founded the Population and Community Development Association (PDA) to take on the task. 

With government investment, Viravaidya and PDA began distributing condoms everywhere low-income communities gathered. Buddhist monks blessed condoms so that people felt safe using them. Shopkeepers received condoms to hand out with every purchase. Teachers were trained to show students the proper use of condoms through fun events like condom blowing contests. 

For people who could afford to spend a little more money on meals, PDA established a chain restaurant, Cabbages and Condoms, so they could hand out free condoms with every bill. Now with locations in England and Japan, Cabbages and Condoms supports the PDA with its profits.

By the year 2000, after 26 years of aggressive condom distribution and promotion, the average family had just 1.5 children. Population growth slowed from 3.3% in 1974 to 0.5%. On top of that, new HIV/AIDS infections fell by 90% between 1991–2003. PDA estimates that 7.7 million lives were saved as a result of condom education in the country. 

To achieve his outstanding goals, Viravaidya used social marketing, which adapts conventional marketing strategies to reach social goals for low-income communities and other vulnerable groups. Social marketing for condoms has been used all over the world to help slow the spread of HIV and give women more autonomy. 

Keep reading to find out more about social marketing tactics and how they’ve been used to promote condoms, saving lives all over the world.   

What is social marketing and why does it matter for condom use?

The Joint United Nations Programme on HIV/AIDS (UNAIDS) defines the ultimate goal of social marketing as instigating “healthy and sustainable behavior change.” Social marketing comes with a mandate to reach low income and vulnerable populations, with the goal to shift perceptions of the status quo so that population health outcomes improve over time. 

Experts apply social marketing principles to movements across a wide spectrum, including the climate crisis, the opioid crisis, and smoking cessation — but social marketing started with condom campaigns during the HIV crisis. 

In the 1980s, as queer men and trans women started dying of AIDS at an alarming rate, condoms were promoted as a way to slow the spread of the disease within a population that hadn’t yet grown accustomed to using them. As HIV/AIDS spread within developing countries, social marketing promoted condoms to populations who weren’t using them for religious and cultural reasons.  

It’s hard to change behavior. Social marketing campaigns need a lot of time to be effective, and the most successful ones get government investment so they can run long enough to see any impact. But even on top of government buy-in, successful social marketing campaigns also need:

• Unconventional distribution networks to reach low income people
• Respected community leaders who know people within the target population    
• Low cost or free products
• Mass marketing campaigns that reduce behavioral stigma

When you’re trying to change stigmatized behavior, the normal rules of marketing and product distribution don’t work. For example, in the 1980s, free condoms were available at reproductive health clinics — accessible for people with vaginas, not so accessible for queer men and trans women who never visited reproductive health clinics. You could, however, find them at bars, truck terminals, and bathhouses — so that’s where the condoms needed to be, too.  

Social condom marketing is high stakes because it’s public health — the success or failure of a campaign means more lives lost or saved from HIV/AIDS. That’s why NGOs and other organizations running successful campaigns learned quickly to lean into the norms of a community and use them to promote condoms in novel ways. Here’s a selection from some of the most successful campaigns throughout the world:

Condom advertising for gay men in the U.S. during the HIV/AIDS crisis

Condom advertising wasn’t legal in the United States until 1977, when a Supreme Court decision invalidated a New York law that prohibited the advertisement and display of contraceptives. But even still, no TV network would air condom ads until well after the AIDS crisis began in 1981. 

Throughout most of the 1980s, President Ronald Reagan insisted on using abstinence-only programs (now proven ineffective) to prevent the spread of AIDS. Conservative attitudes during that time are why the first national broadcast TV ad for condoms didn’t run until 1991, when FOX aired a spot for Trojan during an episode of the short-lived sitcom “Herman's Head”.

Now lost to history, the condom ad features a 24-year-old guy who says into the camera: “I'm a nice guy and go out with nice girls. But these days, some pretty terrible things are happening to some really nice people.” The viewer sees a box of condoms as an announcer says, “Trojan latex condoms: To reduce the risk.” 

But well before this timid tip-toe into condom advertising, the gay community were taking care of their own with condom information in print. In 1982, before medical professionals recommended condoms to protect against AIDS, Michael Callen and Richard Berkowitz, two gay men living with AIDS in New York, published How to Have Sex in an Epidemic, a guide to safe sex for the gay community. The manual was one of the first publications to recommend condoms to prevent STIs for men having sex with men.

The publication isn’t a flashy ad because it wasn’t developed by marketers — it was developed by gay men living with AIDS who knew their own community and what gay men needed. Berkowitz and Callen knew it would be ridiculous to push abstinence on gay men — why should they stop having sex when they were already so prohibited from expressing their sexuality in the first place?

Catchier print ads wouldn’t come until later in the mid-1980s, when Baltimore-based non-profit Health Education Resource Organization (HERO) developed one of the first condom print PSAs for gay men. While at first glance the men look so much alike they could be brothers, the bold headline copy and the use of the word “partner” were clear signals to gay men that condoms could protect them. 

But there was a problem with the ad: It communicated that AIDS only affected white gay men. While the HERO did release another ad that featured Black gay men later that year, Black LGBTQ+ organizations were mostly left to their own devices to address the needs of their own communities. In 1985, a year before HERO’s ad, the Black Gay and Lesbian Leadership Forum in Los Angeles released this poster, calling condoms “rubbers” and stressing their importance for protecting the person you love. 

By the time condoms were “okay” to advertise on TV, they weren’t targeting gay men. Ads funded by the government through the Ad Council adopted an “everyone is at risk” message, which broadened reach but erased queer men, who were still at higher risk of contracting the virus. Just as gay organizations like ACT UP advocated for more AIDS research while the FDA lagged, other gay organizations and non-profits took up the task of educating their own community about condom use.   

Condom advertising in Kenya: Social marketing backfires

In 2013, a condom ad commissioned by Kenyan health officials to help stop the spread of HIV backfired when outrage from religious leaders forced them to take it down. 

The ad, produced by USAID and UK Aid, features a conversation between two women, one of whom is talking about how she has sex with someone other than her husband. The other woman warns her to use condoms to protect herself (as they watch the man flirt with another woman at a market), even though she and her boyfriend have known each other for a long time. 

The ad was produced after a survey by Kenyan health officials revealed that between 20%–30% of married couples have sex with partners other than their spouse, but that most of them don’t use condoms. 

But while the ad may have been telling an important truth about an aspect of life in Kenya (no different than in other countries, really), many people weren’t ready to see it on television. Some people said they were embarrassed by the ad, while one woman told the BBC she was bothered by the fact that it used mother figures to convey the message. 

While Kenyan health officials ultimately stood by the message, the ad was taken down after vocal religious leaders expressed outrage. Regardless of whether the ad should have been removed or not, it’s a good example of the obstacles social condom marketing can face when addressing stigmatized behavior. No matter how badly the public needs to hear the message, sometimes they just aren’t ready.

Previous condom campaigns in Kenya have approached the subject with humor-based advertising, which seems to have worked much better for this famous ad by Trust, a Kenyan condom brand with a popular Twitter account.

Condom advertising in Myanmar: Social marketing hit

In 2006, American NGO Population Services International (PSI) advertised condom use in Myanmar with a recognizable cultural symbol: the chameleon. 

In Myanmar, it’s common for young boys to play a game when they see a chameleon, which is called a “pothinyo” in Burmese. When a chameleon is spotted in the wild (a pretty common occurrence), the boys chant, “Pothinyo, nod your head if you want a girl!” If the chameleon nods its head, it’s obviously a sign it wants to have sex and the little boys think this is funny. 

PSI used this cultural tidbit of information in a campaign for its brand of condoms, Aphaw, which are subsidized to make them affordable for a low income population. PSI advertised Aphaw by turning the boys’ childhood chant on its head: “Pothinyo, nod your head if you want an Aphaw!”

After the campaign ended, 82% of the urban Burmese population recognized the chameleon as a symbol of HIV/AIDS prevention. 

The results of social condom marketing

Social condom marketing programs have had varying levels of success in different countries and with different groups of people. But overall, we wouldn’t have been able to control the spread of HIV throughout the world without them.

According to UNAIDS, social condom marketing was responsible for the distribution of 900 million male and female condoms by 1997. By 1999, at least 71 such campaigns were active in 59 developing countries. 

More recently, AIDS-related deaths have decreased by 64% since they peaked in 2004. While much of that reduction has been due to advancements in HIV therapies, condom education and distribution have also played a massive part in preventing the HIV virus from spreading in the first place. UNAIDS estimates that, “If condom use rates are increased to reach 95% coverage of higher-risk sex acts by 2025 and all other prevention interventions remain at 2019 coverage levels, about one third of the required reductions in new HIV infections will be achieved.”

While so much of what we know about condom advertising is that it’s either funny or controversial, the more important story is that, in a lot of cases, it’s saved lives. We have a lot to learn from social marketing principles that can be applied to other life-saving initiatives, like climate campaigns and the opioid crisis. Let’s hope more smart people take note and apply social marketing tactics where they matter most.